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Caccese M, Desideri I, Padovan M, Bruno F, Cerretti G, Fiorentino A, Denaro L, Chioffi F, Della Puppa A, Maccari M, Cavallin F, Coppola M, Pittaro A, Rudà R, Livi L, Lombardi G. Association between thyroid function and regorafenib efficacy in patients with relapsed wild-type IDH glioblastoma: a large multicenter study. J Neurooncol 2023; 163:377-383. [PMID: 37264256 PMCID: PMC10322943 DOI: 10.1007/s11060-023-04356-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE Regorafenib demonstrated encouraging results in recurrent glioblastoma patients. Some studies showed that changes in circulating thyroid hormones (fT3, fT4, fT3/fT4 ratio) can be considered as prognostic factors in patients with various types of tumors. We designed this study to investigate the relationship between baseline thyroid variables and outcome in IDH-wild type GBM patients who were treated with regorafenib. METHODS This multicenter retrospective study included recurrent IDH-wild-type glioblastoma patients treated with regorafenib. Only patients with baseline thyroid function values (TSH, fT3, fT4, fT3/fT4 ratio) available were evaluated. RANO criteria were used to analyze neuroradiological response. Survival curves were estimated using the Kaplan-Meier method. The relationships between baseline thyroid variables (TSH, fT3, fT4, fT3/fT4) and survival (PFS, OS) were investigated with Cox regression models. RESULTS From November 2015 to April 2022, 134 recurrent IDH-wildtype GBM patients were treated with regorafenib and 128 of these had information on baseline thyroid function value. Median follow-up was 8 months (IQR 4.7-14.0). Objective Response Rate was 9% and Disease Control Rate was 40.9%. Median PFS was 2.7 months (95%CI 2.2-3.6) and median OS was 10.0 months (95%CI 7.0-13.0). Lower baseline TSH value in the blood was correlated with a higher rate of disease progression to regorafenib (p = 0.04). Multivariable analyses suggested a non-linear relationship between PFS (p = 0.01) and OS (p = 0.03) with baseline fT3/fT4 ratio. CONCLUSION In recurrent wild-type IDH glioblastoma patients, baseline fT3/fT4 ratio showed a non-linear relationship with survival, with different impacts across the spectrum of fT3/fT4 ratio. Moreover, baseline TSH may be a predictor of regorafenib activity.
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Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy.
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Francesco Bruno
- Division of Neuro-Oncology, Department Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Alba Fiorentino
- Department of Medicine, LUM Giuseppe Degennaro University, Casamassima, Bari, Italy
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences DNS, University of Padua, Padua, Italy
| | - Franco Chioffi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Alessandro Della Puppa
- Neurosurgical Clinical Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Marta Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | | | - Marina Coppola
- Pharmacy, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Alice Pittaro
- Radiology Unit, Department of Imaging and Medical Physics, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department Neuroscience, University and City of Health and Science Hospital, Turin, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
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Insights on the Association between Thyroid Diseases and Colorectal Cancer. J Clin Med 2023; 12:jcm12062234. [PMID: 36983233 PMCID: PMC10056144 DOI: 10.3390/jcm12062234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/22/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
Benign and malignant thyroid diseases (TDs) have been associated with the occurrence of extrathyroidal malignancies (EMs), including colorectal cancers (CRCs). Such associations have generated a major interest, as their characterization may provide useful clues regarding diseases’ etiology and/or progression, with the possible identification of shared congenital and environmental elements. On the other hand, elucidation of the underlying molecular mechanism(s) could lead to an improved and tailored clinical management of these patients and stimulate an increased surveillance of TD patients at higher threat of developing EMs. Here, we will examine the epidemiological, clinical, and molecular findings connecting TD and CRC, with the aim to identify possible molecular mechanism(s) responsible for such diseases’ relationship.
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KAPLAN İ, CAN C, KÖMEK H, KEPENEK F, SOYLU H, ERDUR E, AGÜLOĞLU N, GÜNDOĞAN C. Is there an association between thyroid function tests and 18F FDG PET/CT parameters in untreated cancer patients? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1107903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives: We aimed to investigate the association between the extent of disease, 18F FDG PET/CT parameters (SUVmax and the highest SUVmax) and thyroid function tests (TFT) (TSH, FT4, FT3, FT3/FT4 ratio, AntiTG, and AntiTPO) in untreated cancer patients.
Material and Method: One hundred and seventy-nine patients who underwent FDG PET/CT for metabolic characterization and staging in our clinic between May 2020 and November 2020 were included in the study. Patients were divided into two groups as malignant and benign according to histopathology findings. Thyroid function tests were ordered from all patients at the time of PET/CT imaging. The association between the presence of local lymph node metastasis, distant metastases and thyroid function tests as well as the association between PET/CT parameters and thyroid function tests in benign and malignant groups were statistically analyzed.
Results: Thyroid function tests did not exhibit a significant difference between patients with malignant and benign disease (p> 0.05). Univariate logistic regression analysis revealed that age, FT4 value, and the FT3/F4 ratio were significant parameters in predicting distant metastases. These parameters were also significant in predicting mortality. Multivariate logistic regression analysis showed that age was an independent prognostic factor predicting mortality.
Conclusion: Thyroid function tests are not decisive in differentiating malignant and benign lesions. While no statistically significant correlation was observed between thyroid function tests and PET/CT parameters, univariate analyses revealed that especially FT4 and FT3/FT4 ratio were significant in predicting disease extent and mortality in malignant disease. Age was found to be an independent prognostic factor in predicting mortality.
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Affiliation(s)
- İhsan KAPLAN
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Canan CAN
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Halil KÖMEK
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Ferat KEPENEK
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Hikmet SOYLU
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, ENDOCRINOLOGY AND METABOLIC DISEASES
| | - Erkan ERDUR
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF INTERNAL MEDICINE, ONCOLOGY
| | - Nurşin AGÜLOĞLU
- UNIVERSITY OF HEALTH SCIENCES, İZMİR DR. SUAT SEREN HEALTH RESEARCH CENTER FOR PULMONOLOGY AND THORACIC SURGERY, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
| | - Cihan GÜNDOĞAN
- UNIVERSITY OF HEALTH SCIENCES, DİYARBAKIR GAZİ YAŞARGİL HEALTH RESEARCH CENTER, DEPARTMENT OF INTERNAL MEDICINE, DEPARTMENT OF NUCLEAR MEDICINE
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Maruzzo M, Verzoni E, Vitale MG, Dionese M, Buti S, Galli L, Zivi A, Watutantrige-Fernando S, Zielli T, Zanardi E, Sabbatini R, Basso U, Zagonel V, Procopio G. Prognostic Value of Thyroid Hormone Ratio in Patients With Advanced Metastatic Renal Cell Carcinoma: Results From the Threefour Study (Meet-URO 14). Front Oncol 2021; 11:787835. [PMID: 34900742 PMCID: PMC8655227 DOI: 10.3389/fonc.2021.787835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Thyroid hormone impairment, represented as an alteration in levels of thyroid hormones and a lower fT3/fT4 ratio, has been correlated with a worse prognosis for both cancer and non-cancer patients. The role of baseline thyroid function in patients with metastatic renal cell carcinoma (mRCC) however, has not been studied yet. Materials and Methods We recorded clinical data, baseline biochemical results, and oncological outcomes from 10 Oncology Units in Italy. We stratified patients into three groups according to the fT3/fT4 ratio value and subsequently analyzed differences in progression-free survival (PFS) and overall survival (OS) in the three groups. We also performed univariate and multivariate analyses to find prognostic factors for PFS and OS. Results We analyzed 134 patients treated with systemic treatment for mRCC. Median PFS in the low, intermediate, and high fT3/fT4 ratio group were 7.5, 12.1, and 21.7 months respectively (p<0.001); median OS in the three groups were 36.5, 48.6, and 70.5 months respectively (p =0.006). The low fT3/fT4 ratio maintained its prognostic role at the multivariate analysis independently from IMDC and other well-established prognostic factors. The development of iatrogenic hypothyroidism was not associated with a better outcome. Conclusion We found that baseline thyroid hormone impairment, represented by a low fT3/fT4 ratio, is a strong prognostic factor in patients treated for mRCC in first line setting and is independent of other parameters currently used in clinical practice.
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Affiliation(s)
- Marco Maruzzo
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Elena Verzoni
- Genito-Urinary (GU) Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Michele Dionese
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy.,Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Sebastiano Buti
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Luca Galli
- Oncology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Andrea Zivi
- Oncology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Sara Watutantrige-Fernando
- Hereditary Tumor Unit, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Teresa Zielli
- Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Elisa Zanardi
- Academic Unit of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Martino Hospital, Genova, Italy
| | - Roberto Sabbatini
- Oncology Unit, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Umberto Basso
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Vittorina Zagonel
- Oncology Unit 1, Istituto Oncologico Veneto, IOV - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Giuseppe Procopio
- Genito-Urinary (GU) Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Istituto Nazionale dei Tumori, Milano, Italy
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Biegelmeyer E, Scanagata I, Alves L, Reveilleau M, Schwengber FP, Wajner SM. T3 as predictor of mortality in any cause non-critically ill patients. Endocr Connect 2021; 10:852-860. [PMID: 34170844 PMCID: PMC8346183 DOI: 10.1530/ec-21-0080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low T3 syndrome refers to a set of thyroid hormone metabolism alterations present in the disease state. A correlation between low T3 and poor clinical outcomes in the intensive care unit is more established. Nonetheless, studies on non-critically ill patients are few and controversial. OBJECTIVE To evaluate the prevalence and predictive value of low T3 levels on 30-day and 6-month mortality in non-critically ill patients. Secondary outcomes evaluated the length of hospital stay, overall mortality, and hospital readmission. DESIGN Prospective cohort study. METHODS A total of 345 consecutive patients from the Internal Medicine ward of a tertiary hospital in southern Brazil were included and followed from October 2018 to April 2019 (6 months). Levels of total serum T3 were measured weekly, from admission to discharge, and correlated with 30-day and 6-month mortality. RESULTS Prevalence of low T3 was 36.6%. Low T3 levels were associated with higher 30-day hospital mortality (15.1% vs 4.1%, P < 0.001) and higher 6-month overall mortality (31.7% vs 13.2%, P < 0.001). Total serum T3 at admission was an independent predictor of 30-day hospital mortality. CONCLUSION Low T3 levels are a prevalent condition among non-critically ill patients, and this condition is associated with poor clinical outcomes in this population. Total serum T3 levels, alone or in association with other predictive scores, were demonstrated to be an easy and valuable tool for risk stratification and should be further employed in this setting.
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Affiliation(s)
- Erika Biegelmeyer
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Iury Scanagata
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Laura Alves
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Murilo Reveilleau
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernando Pereira Schwengber
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Simone Magagnin Wajner
- Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Correspondence should be addressed to S M Wajner:
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Schwarz Y, Percik R, Oberman B, Yaffe D, Zimlichman E, Tirosh A. Sick Euthyroid Syndrome on Presentation of Patients With COVID-19: A Potential Marker for Disease Severity. Endocr Pract 2021; 27:101-109. [PMID: 33551316 PMCID: PMC7834506 DOI: 10.1016/j.eprac.2021.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Precise risk stratification and triage of coronavirus disease 2019 (COVID-19) patients are essential in the setting of an overwhelming pandemic burden. Clinical observation has shown a somewhat high prevalence of sick euthyroid syndrome among patients with COVID-19. This study aimed to evaluate the predictive value of free triiodothyronine (FT3) at the clinical presentation of COVID-19 for disease severity and death. METHODS This retrospective cohort study was based on electronic medical records. The study was conducted at Sheba Medical Centre, a tertiary hospital where several acute and chronic wards have been dedicated to the treatment of patients with COVID-19. The primary outcome measure was death during hospitalization; secondary outcomes included hospitalization in intensive care, mechanical ventilation, and length of hospitalization. RESULTS Of a total of 577 polymerase chain reaction-positive patients with COVID-19 hospitalized between February 27 and July 30, 2020, 90 had at least 1 measurement of thyroid-stimulating hormone, free thyroxine, and FT3 within 3 days of presentation. After applying strict exclusion criteria, 54 patients were included in the study. Patients in the lowest tertile of FT3 had significantly higher rates of mortality (40%, 5.9%, and 5.9%, P = .008), mechanical ventilation (45%, 29.4%, and 0.0%; P = .007) and intensive care unit admission (55%, 29.4%, and 5.9%, P = .006). In multivariate analyses adjusted for age, Charlson comorbidity index, creatinine, albumin, and white blood cell count. FT3 remained a significant independent predictor of death. CONCLUSION FT3 levels can serve as a prognostic tool for disease severity in the early presentation of COVID-19.
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Affiliation(s)
- Yair Schwarz
- Dalia and David Arabov Endocrinology and Diabetes Research Center, Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Ruth Percik
- Dalia and David Arabov Endocrinology and Diabetes Research Center, Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Bernice Oberman
- Gertner Institute for Epidemiology and Health Policy, Sheba Medical Center, Tel Hashomer, Israel
| | - Dana Yaffe
- MDClone, HaEnergia Street 77, Be'er Sheva, Israel
| | - Eyal Zimlichman
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Central Management, Sheba Medical Center, Tel Hashomer, Israel
| | - Amir Tirosh
- Dalia and David Arabov Endocrinology and Diabetes Research Center, Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
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M C, R V, C P, M C, G S, N P, E P, Ziranu A, G M. Euthyroid sick syndrome in hip fractures: Evaluation of postoperative anemia. Injury 2020; 51 Suppl 3:S9-S12. [PMID: 32669206 DOI: 10.1016/j.injury.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Incidence of hip fractures is increasing with upward estimates representing one of the most current health problems. According to some authors this condition is associated with an early mortality rate ranging between 20% and 35% and low outcomes. One of the predictive factors of poor outcome after hip fracture is anaemia. In fragile patients, hormonal changes due to fracture and surgical trauma, may occur in the hypophyseal hypothalamus axis which may lead to the Euthyroid Sick Syndrome (ESS). This pathological condition is characterized by a reduction in the concentration of triiodothyronine (T3) with normal or slightly reduced thyrotropin (TSH) values and with or without a reduction (cancellata) of thyroxine (T4). ESS has been associated to an increased mortality in elderly patients. MATERIALS AND METHODS Inclusion criteria were: age > 65y, X-ray diagnosis of proximal femoral fracture classified as AO 31A or 31B requiring surgical treatment, admittance to the emergency room within 72 hours from trauma. Exclusion criteria were: any thyroid-related pathology, concomitant acute coronary syndrome, active pneumonia, concomitant neoplastic disease, assumption of medications able to affect thyroid function, refusal to undergo surgical treatment. All patients underwent routine blood testing and a complete thyroid-hormone profile dosage before surgical operation. The same blood tests performed before surgical operation were repeated on the first and third post-operative days. RESULTS Thirtytwo patients met the inclusion criteria and were enrolled after they accepted to participate to the study. Sixteen patients presented with ESS on admission and 16 patients did not. The mean age was 82,5 yo. There was no statistically significant difference in bleeding risk factors among the two groups. In the ESS group there was a number of blood transfusions of 1.06 units higher than the control group (p=0.01). CONCLUSIONS We have demonstrated that patients with ESS have a higher need of red blood cells transfusion compared to patients without ESS and, thus they have a higher risk to develop anemia in the peri-operative period. We believe it would be useful to diagnose ESS in fragile patients at their arrival to the emergency room and apply a peri-operative therapeutic protocol to prevent anemia.
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Affiliation(s)
- Cauteruccio M
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Vitiello R
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Perisano C
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Covino M
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Sircana G
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - Piccirillo N
- UOC Emotrasfusione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pesare E
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
| | - A Ziranu
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore.
| | - Maccauro G
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore
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Spaziani M, Semeraro A, Bucci E, Rossi F, Garibaldi M, Papassifachis MA, Pozza C, Anzuini A, Lenzi A, Antonini G, Radicioni AF. Hormonal and metabolic gender differences in a cohort of myotonic dystrophy type 1 subjects: a retrospective, case-control study. J Endocrinol Invest 2020; 43:663-675. [PMID: 31786795 DOI: 10.1007/s40618-019-01156-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/23/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE Myotonic dystrophy type 1 (DM1) is a genetic disorder caused by CTG expansion in the DMPK gene. The aim was to investigate the endocrine and metabolic aspects of DM1. PATIENTS AND METHODS Retrospective, case-control study. We compared pituitary, thyroid, adrenal, gonadal and liver function and glycolipid metabolism of 63 DM1 patients against 100 control subjects. Given age-related differences, 2 further subgroups were created to investigate the pituitary-gonadal axis: < 41 (1a) and ≥ 41 (1b) years old for male subjects and < 46 (2a) and ≥ 46 (2b) years old for female subjects. Testicular and thyroid ultrasounds were also performed in the DM1 group. RESULTS FT3 and FT4 were significantly lower in DM1 men than controls, while for both males and females, thyroglobulin, ACTH and cortisol were significantly higher in the DM1 group. Gonadotropin levels were significantly higher and inhibin B and DHEA-S levels significantly lower in DM1 patients than controls for both male subgroups. Testosterone and SHBG were significantly higher in controls than in patients for subgroup 1a. Prolactin was significantly higher in patients in subgroups 1b, while testosterone was lower in subgroup 2a than in age-matched female controls. A correlation between the number of CTG repeats and the percentage of male hypogonadal subjects was found. Finally, there was a worse glucose and lipid pattern and significantly higher transaminase and gamma-GT levels in both male and female patients. CONCLUSIONS The high frequency of endocrine and metabolic abnormalities in DM1 highlights the importance of endocrine monitoring to enable the prompt initiation of a suitable therapy.
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Affiliation(s)
- M Spaziani
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy.
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy.
| | - A Semeraro
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - E Bucci
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - F Rossi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - M Garibaldi
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - M A Papassifachis
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - C Pozza
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
| | - A Anzuini
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
| | - G Antonini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - A F Radicioni
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Policlinico Umberto I, Sapienza University of Rome, Level - 1, Room 33, Rome, Italy
- Centre for Rare Diseases, Policlinico Umberto I, Rome, Italy
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Valentini A, Cianfarani MA, Tarantino U, Di Daniele N, Bertoli A. Osteoprotegerin as a biomarker of geriatric frailty syndrome. Aging (Albany NY) 2019; 11:4900-4909. [PMID: 31311890 PMCID: PMC6682533 DOI: 10.18632/aging.102083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
The lack of a univocal definition of frailty, a condition frequently found in the elderly population which is correlated with an increased risk of mortality, has prompted the search for clinical and laboratory parameters associated with this condition. Whereas OPG is a protein involved in different pathophysiological conditions including bone, vascular, immune and tumor disease and studies found a positive linear correlation between OPG and age we hypothesized that it may represent a frailty marker in the elderly.We conducted an observational study of 172 elderly subjects, with and without hip fracture, including a multidimensional geriatric evaluation and a laboratory evaluation, aimed to evaluate the association between OPG and frailty.Frailty Score was associated with FT3 and osteoprotegerin (OPG), regardless of fracture event. Excluding subjects with hip fracture, in whom the acute event had a direct effect on bone production of OPG, the Frailty Score showed a linear correlation with circulating levels of osteoprotegerin.In the elderly, an increase in osteoprotegerin levels may reflect a progressive accumulation of organ damage leading to the development of frailty. The correlation between OPG and Frailty Score found in our study points to its potential use as a biomarker for geriatric frailty syndrome.
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Affiliation(s)
- Alessia Valentini
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Aldo Bertoli
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Schirripa M, Pasqualetti G, Giampieri R, Scartozzi M, Lonardi S, Rumanò L, Bergamo F, Stragliotto S, Murgioni S, Alberti G, Rizzato MD, Prete AA, Puzzoni M, Pusceddu V, Ziranu P, Pani F, Mariotti S, Zagonel V, Monzani F, Loupakis F. Prognostic Value of Thyroid Hormone Ratios in Patients With Advanced Metastatic Colorectal Cancer Treated With Regorafenib: The TOREADOR Study. Clin Colorectal Cancer 2018; 17:e601-e615. [DOI: 10.1016/j.clcc.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/03/2018] [Accepted: 05/31/2018] [Indexed: 12/27/2022]
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11
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Pasqualetti G, Calsolaro V, Bernardini S, Linsalata G, Bigazzi R, Caraccio N, Monzani F. Degree of Peripheral Thyroxin Deiodination, Frailty, and Long-Term Survival in Hospitalized Older Patients. J Clin Endocrinol Metab 2018; 103:1867-1876. [PMID: 29546287 DOI: 10.1210/jc.2017-02149] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/07/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Although the association between low free triiodothyronine (FT3) and poor outcome has been extensively reported in literature, the degree of peripheral thyroxin deiodination and its relationship with frailty and survival in hospitalized older patients has not yet been fully established. The aim of the current study was to evaluate the possible correlation between FT3/free thyroxine (FT4) ratio reduction, an indirect marker of thyroxin deiodination impairment, and frailty status and survival in hospitalized older patients. METHODS We consecutively enrolled older patients, hospitalized in the geriatrics ward of the University of Pisa. At admission, Multidimensional Geriatric Assessment (MGA) and Multi Prognostic Index (MPI), an indirect measure of frailty, were obtained from all the patients. Causes of hospitalization and prevalence of delirium were recorded. Blood samples for FT3, FT4, and thyrotropin value evaluation were drawn after an overnight fast. RESULTS A total of 643 patients (83.8 ± 7.4 years, 53% women) were studied. FT3 was inversely and strongly correlated, whereas FT4 was moderately positively correlated with MGA parameters, MPI score (P < 0.001 and P < 0.05, respectively), and survival (P < 0.001 and P = 0.09, respectively). FT3/FT4 ratio reduction was highly associated with worse MGA (P < 0.001) and MPI scores (P < 0.0001), even in patients without low FT3. The inclusion of FT3 in the final model of multivariate Cox regression confirmed the independent role of FT3/FT4 ratio in predicting survival (P = 0.005). CONCLUSION Overall, our study documented a strong association between FT3/FT4 ratio reduction, a surrogate marker of peripheral thyroxin deiodination, and frailty. Moreover, FT3/FT4 ratio value emerged as independent marker of survival, even in patients with normal FT3 values.
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Affiliation(s)
- Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Neurology Imaging Unit, Imperial College, London, United Kingdom
| | - Sara Bernardini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Linsalata
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Renato Bigazzi
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Bashkin A, Yaakobi E, Nodelman M, Ronen O. Is routine measurement of TSH in hospitalized patients necessary? Endocr Connect 2018; 7:567-572. [PMID: 29572406 PMCID: PMC5900452 DOI: 10.1530/ec-18-0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/23/2018] [Indexed: 01/07/2023]
Abstract
TSH routine testing in hospitalized patients has low efficacy, but may be beneficial in a selected subgroup of patients. Our aim was to evaluate the efficacy of routine thyroid function tests among patients admitted to internal medicine departments. It is a retrospective study. A randomly selected cohort of hospitalized patients with abnormal thyroid-stimulating hormone (TSH) blood tests drawn as part of admission protocol. Patient data were collected from the electronic medical files and analyzed for its efficacy. TSH as a screening test was proven unnecessary in 75% (174) of the study population. Leading causes were non-thyroidal illness syndrome, drugs affecting the test results and subclinical disorders. TSH testing was found to be clinically helpful in only 9 patients; however, all of them had other clinical need for TSH testing. We found a clinically abnormal TSH in 20 patients, hypothyroidism in 11 patients and thyrotoxicosis in 9 patients. Low efficacy ascribed to TSH screening test by this study correlates with recent recommendations that indicate TSH screening in admitted patients only with accompanying clinical suspicion. Most probably, the majority of patients found by screening to have thyrotoxicosis have non-thyroidal illness or drug effects so the threshold for FT4 to diagnose overt thyrotoxicosis should be higher than that in ambulatory patients. In elderly patients, clinically relevant TSH disturbances are more frequent and are harder to diagnose, therefore, TSH screening in this group of patients might be beneficial.
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Affiliation(s)
- Amir Bashkin
- Department of EndocrinologyGalilee Medical Center, Nahariya, Israel
- Azrieli Faculty of MedicineBar-Ilan University, Safed, Israel
| | - Eliran Yaakobi
- Azrieli Faculty of MedicineBar-Ilan University, Safed, Israel
| | - Marina Nodelman
- Department of EndocrinologyGalilee Medical Center, Nahariya, Israel
- Azrieli Faculty of MedicineBar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Azrieli Faculty of MedicineBar-Ilan University, Safed, Israel
- Department of Otolaryngology Head and Neck SurgeryGalilee Medical Center, Nahariya, Israel
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Sforza N, Rosenfarb J, Rujelman R, Rosmarin M, Blanc E, Frigerio C, Fossati P, Caruso D, Faingold C, Meroño T, Brenta G. Hypothyroidism in hospitalized elderly patients: a sign of worse prognosis. J Endocrinol Invest 2017; 40:1303-1310. [PMID: 28534147 DOI: 10.1007/s40618-017-0690-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/10/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Overt hypothyroidism has adverse clinical consequences and might worsen prognosis in critically ill elderly patients. However, the difficult interpretation of thyroid function tests (TFT) due to non-thyroidal illness (NTI) has led to discouragement of screening for thyroid dysfunction. Our aim was to determine the prevalence of TFT compatible with hypothyroidism and to study its influence on mortality among hospitalized elderly patients. METHODS In this prospective study we consecutively included all patients ≥60 years admitted by the Internal Medicine Department to the hospital ward (n = 451) of the Cesar Milstein Hospital in Buenos Aires, Argentina. TFT were done on day 1 and 8. Thyroid function categories were defined as overt and subclinical hypothyroidism, overt and subclinical hyperthyroidism, euthyroidism and NTI. Stage of chronic kidney disease (CKD), Adult Comorbidity Evaluation (ACE)-27, and intra-hospital mortality were recorded. The association between mortality and TFT categories was studied by Cox regression. RESULTS Out of 451 patients (77.0 ± 7.9 years, 54% females) 76% were categorized as NTI, 4% as overt hypothyroid, 10% as subclinical hypothyroid, 1% as subclinical hyperthyroid and 9% as euthyroid. Overt hypothyroid patients showed significantly higher mortality than the rest of the groups (25%, p < 0.05) while ACE-27 was similar among all of them (p = 0.658). In addition, patients within the overt hypothyroid category showed a higher mortality rate than NTI in a model adjusted by Stage 5-CKD, ACE-27, sex and age [HR 3.1 (1.14-8.41), p < 0.026]. CONCLUSION Overt hypothyroidism during hospitalization was associated with elevated mortality. Further studies would reveal if TFT alterations compatible with hypothyroidism should be diagnosed/treated in hospitalized elderly patients.
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Affiliation(s)
- N Sforza
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - J Rosenfarb
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - R Rujelman
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - M Rosmarin
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - E Blanc
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - C Frigerio
- Biochemistry Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - P Fossati
- Biochemistry Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - D Caruso
- Internal Medicine Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - C Faingold
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina
| | - T Meroño
- Clinical Biochemistry Department, Pharmacy and Biochemistry School, 954 Junin St, 1113, Buenos Aires, Argentina
| | - G Brenta
- Endocrinology Department, Cesar Milstein Hospital, 951 La Rioja St, 1221, Buenos Aires, Argentina.
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Ruggeri RM, Trimarchi F, Biondi B. MANAGEMENT OF ENDOCRINE DISEASE: l-Thyroxine replacement therapy in the frail elderly: a challenge in clinical practice. Eur J Endocrinol 2017; 177:R199-R217. [PMID: 28566447 DOI: 10.1530/eje-17-0321] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/16/2017] [Accepted: 05/31/2017] [Indexed: 12/11/2022]
Abstract
The number of elderly people, mostly aged over 85 years (the 'oldest old'), is increasing worldwide. As a consequence, accompanying morbidity and disability have been increasing, and frailty, defined as an age-related condition of decline of physiological reserves and vulnerability, represents an emerging problem. Caring for older frail people may represent a challenge, since the elderly differ significantly from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions. Specific criteria of therapeutic appropriateness and modified goals of care are needed in such patients, also in endocrine care settings. Indeed, thyroid dysfunctions are among the most common conditions in older, multimorbid populations. The prevalence of overt and subclinical hypothyroidism is as high as 20% and thyroid hormone prescription is common in the elderly, with a trend toward levothyroxine treatment of more marginal degrees of hypothyroidism. In addition, older patients have the highest rate of overtreatment during replacement therapy and are more susceptible to developing adverse effects from thyroid hormone excess. Recently, results of a multicentric randomized controlled trial, the TRUST-IEMO collaboration trial, added further insights to the debated question of whether and when levothyroxine treatment is required and if it is beneficial in the elderly. With this in mind, we revised the relevant literature on the impact of thyroid dysfunction and replacement therapy among older people, with the aim to better define indications, benefits and risks of l-T4 replacement therapy in the frail elderly.
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Affiliation(s)
- R M Ruggeri
- Department of Clinical and Experimental Medicine, UOC Endocrinology, University of Messina, Italy
| | - F Trimarchi
- Accademia Peloritana dei Pericolanti, University of Messina, Messina, Italy
| | - B Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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15
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Kara O, Canbaz B, Kizilarslanoglu MC, Arik G, Sumer F, Aycicek GS, Varan HD, Kilic MK, Dogru RT, Cınar E, Kuyumcu ME, Yesil Y, Ulger Z, Yavuz BB, Halil M, Cankurtaran M. Which parameters affect long-term mortality in older adults: is comprehensive geriatric assessment a predictor of mortality? Aging Clin Exp Res 2017; 29:509-515. [PMID: 27137217 DOI: 10.1007/s40520-016-0574-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/13/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Determining predictors of mortality among older adults might help identify high-risk patients and enable timely intervention. AIMS The aim of the study was to identify which variables predict geriatric outpatient mortality, using routine geriatric assessment tools. METHODS We analyzed the data of 1141 patients who were admitted to the geriatric medicine outpatient clinic between 2001 and 2004. Comprehensive geriatric assessment was performed by an interdisciplinary geriatric team. Mortality rate was determined in 2015. The parameters predicting survival were examined. RESULTS Median age of the patients (415 male, 726 female) was 71.7 years (53-95 years). Mean survival time was 12.2 years (95 % CI; 12-12.4 years). In multivariate analysis, age (OR: 1.16, 95 % CI: 1.09-1.23, p < 0.001), smoking (OR: 2.51, 95 % CI: 1.18-5.35, p = 0.017) and metabolic syndrome (OR: 2.20, 95 % CI: 1.05-4.64, p = 0.038) were found to be independent risk factors for mortality. MNA-SF scores (OR: 0.84, 95 % CI: 0.71-1.00, p = 0.050) and free T3 levels (OR: 0.70, 95 % CI: 0.49-1.00, p = 0.052) had borderline significance. DISCUSSION The present study showed that the risk conferred by metabolic syndrome is beyond its individual components. Our findings confirm previous studies on the prognostic role of nutritional status, as reflected by MNA-SF. Serum fT3, a simple laboratory test, may also be used in geriatric outpatient clinics to identify individuals at risk. CONCLUSIONS The results of the study demonstrated the need for addressing modifiable risk factors such as smoking, metabolic syndrome, and undernutrition in older adults.
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16
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Bertoli A, Valentini A, Cianfarani MA, Gasbarra E, Tarantino U, Federici M. Low FT3: a possible marker of frailty in the elderly. Clin Interv Aging 2017; 12:335-341. [PMID: 28228654 PMCID: PMC5312686 DOI: 10.2147/cia.s125934] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction Frailty is associated with a functional decline of multiple physiological systems, of which they may be a cause or consequence. The objective of the study was to evaluate the prevalence of thyroid hormone modifications in elderly frail subjects and its relationship with frailty. Study population and methods An observational study was carried out at the University Hospital “Tor Vergata” in Rome among ambulatory and hospitalized patients. The study population consisted of 112 elderly subjects: 62 were hospitalized following hip fracture and 50 control subjects were outpatients. Participating patients received a multidimensional geriatric evaluation. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) was used to assess the degree of frailty. Thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured to evaluate thyroid status. Results FT3, but not FT4, was significantly correlated with Frailty score, both in patients with hip fracture and in patients from the control group. In the entire study population, FT3 under normal limits is effective in discriminating frail/prefrail subjects from nonfrail subjects. Discussion The reduction in serum concentrations of FT3 is a clear manifestation of stress associated with fractures. Numerous preexisting factors, such as the fracture patients’ nutritional status, sarcopenia, disability and comorbidities, which characterize the condition of frailty and influence its pathogenesis, are strongly correlated with FT3 values, suggesting the existence of latent nonthyroidal illness syndrome (NTIS). Conclusion We conclude that measuring FT3 can be a useful laboratory parameter in clinical assessment, which can play an important role in identifying vulnerable elderly subjects and in quantifying the condition of frailty.
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Affiliation(s)
- Aldo Bertoli
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Alessia Valentini
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | | | - Elena Gasbarra
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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De Alfieri W, Borgogni T, Costanzo S, Nisticò F. Biologic Resilience of Elderly Hospitalized Patients. J Gerontol A Biol Sci Med Sci 2017; 72:140-141. [DOI: 10.1093/gerona/glw162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/30/2016] [Indexed: 11/12/2022] Open
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Abstract
In this review, we discuss the characteristics, pathophysiology, and therapeutic implications of the euthyroid sick syndrome. Multiple mechanisms have been identified to contribute to the development of euthyroid sick syndrome, including alterations in the iodothyronine deiodinases, thyroid-stimulating hormone secretion, thyroid hormone binding to plasma protein, transport of thyroid hormone in peripheral tissues, and thyroid hormone receptor activity. The euthyroid sick syndrome appears to be a complex mix of physiologic adaptation and pathologic response to acute illness. The underlying cause for these alterations has not yet been elucidated. Treatment of the euthyroid sick syndrome with thyroid hormone to restore normal serum thyroid hormone levels in an effort to improve disease prognosis and outcomes continues to be a focus of many clinical studies, although currently available data do not provide evidence of a clear benefit of treatment.
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Affiliation(s)
- Sun Lee
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Alan P Farwell
- Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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19
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Thyroid function tests and early outcomes of acute ischemic stroke in older euthyroid patients. Exp Gerontol 2015; 61:8-14. [DOI: 10.1016/j.exger.2014.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/05/2014] [Accepted: 11/16/2014] [Indexed: 11/23/2022]
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20
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Factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. J Aging Res 2014; 2014:584315. [PMID: 25147737 PMCID: PMC4131474 DOI: 10.1155/2014/584315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 12/17/2022] Open
Abstract
Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%). Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6%) of the hospitalized patients were discharged, 85 (8.4%) died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.
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Bai MF, Gao CY, Yang CK, Wang XP, Liu J, Qi DT, Zhang Y, Hao PY, Li MW. Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis. J Cardiol 2014; 64:496-500. [PMID: 24951271 DOI: 10.1016/j.jjcc.2014.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/10/2014] [Accepted: 03/15/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Abnormal thyroid hormone metabolism influences the occurrence and progress of coronary heart disease (CHD). The aim of the present study was to analyze the severity of coronary artery lesions and the prognosis of thyroid dysfunction patients admitted for coronary angiography (CAG). METHODS From July 2011 to July 2012, 605 consecutive patients with suspected coronary heart disease admitted for CAG were selected. The patients were divided into three groups, based on their thyroid function prior to CAG: euthyroid group (n=455 patients), low T3 syndrome group (n=96 patients), and hypothyroidism group (n=54 patients). All patients underwent CAG. Then the severity of coronary artery lesions was assessed by Gensini scores. All patients were followed up for major adverse cardiac events. RESULTS The prevalence of CHD in low T3 syndrome group and hypothyroidism group was significantly higher than that in the euthyroid group (p<0.001 and p=0.004, respectively). Moreover, the severity of coronary artery lesions in low T3 syndrome group and hypothyroidism group was significantly greater than that in the euthyroid group (all p<0.001). Multinomial logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of coronary artery moderate [odds ratio (OR)=4.268, 95% CI: 3.294-7.450, p=0.016] and severe (OR=4.294, 95% CI: 2.259-9.703, p<0.001) lesions. The mean duration of follow-up was 15.3±3.8 months; patients with thyroid dysfunction had a significantly worse prognosis as compared to those in the euthyroid group for the composite end-point (p<0.01). Moreover, the incidence of the composite end-point (all-cause death, non-fatal myocardial infarction, and coronary revascularization) was significantly higher in low T3 syndrome group and hypothyroidism group compared with that of in the euthyroid group (all p<0.001). CONCLUSIONS The patients with hypothyroidism and low T3 syndrome had a high prevalence of CHD, increased severity of coronary artery lesions and poor prognosis.
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Affiliation(s)
- Min-fu Bai
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Chuan-yu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China.
| | - Chao-kuan Yang
- Department of Cardiology, Henan Medical College for Staff and Workers, Xinzheng, China.
| | - Xian-pei Wang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Jun Liu
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Da-tun Qi
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - You Zhang
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China; Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
| | - Pei-yuan Hao
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Mu-wei Li
- Department of Cardiology, Zhengzhou University People's Hospital, Zhengzhou, China
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Li H, Yuan X, Liu L, Zhou J, Li C, Yang P, Bu L, Zhang M, Qu S. Clinical evaluation of various thyroid hormones on thyroid function. Int J Endocrinol 2014; 2014:618572. [PMID: 25548564 PMCID: PMC4274666 DOI: 10.1155/2014/618572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/24/2014] [Indexed: 11/17/2022] Open
Abstract
To clarify the clinical value of serums total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), and free thyroxine (FT4) and provide a more eligible and economic strategy to assess thyroid function. A total of 2,673 participants (500 patients with hyperthyroidism, 500 patients with hypothyroidism, and 1,673 healthy people) were involved in our study. Serums TT3, TT4, FT3, and FT4 and thyrotropin (TSH) were measured with VIDAS fluorescent enzyme immunoassay. The Pearson correlation between TT3, TT4, FT3, and FT4 and TSH was determined to identify the most important indicator for thyroid function besides TSH. The correlation of TT4, and FT4 with TSH was statistically significant in healthy individuals (P < 0.01), and the R-values were -0.065 and -0.152, respectively. The correlation of TT4, FT4, TT3, and FT3 with TSH was statistically significant in patients with hyperthyroidism, and the R-values were -0.241, -0.225, -0.195, and -0.176, respectively. The correlation of TT4, FT4, TT3, and FT3 with TSH was statistically significant in patients with hypothyroidism, and the R-values were -0.322, -0.262, -0.179, and -0.136, respectively. In our opinion, TSH and FT4 are the most valuable indicators in assessing thyroid function in a healthy population, and TSH and TT4 are the most meaningful in hyperthyroidism and hypothyroidism.
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Affiliation(s)
- Hong Li
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
- *Hong Li:
| | - Xiaolan Yuan
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Lu Liu
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Jiaojiao Zhou
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Chunyan Li
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Peng Yang
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Le Bu
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Manna Zhang
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
| | - Shen Qu
- Department of Endocrinology, Shanghai Tenth People's Hospital, .
Tongji University School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
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